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THE QUANTIFIED DOCTOR
  Self Tracking and Medical Care
         Paul Abramson MD
      My Doctor Medical Group
        UCSF Clinical Faculty
         @paulabramsonMD
“Many of the people who come to my
office .. have come because modern medicine
  has failed them in some way, or they have
  used up its power to help them and they
           know not what else to do”

       -- Rachel Naomi Remen, MD
BS, MS Electrical Engineering
“the last bubble”



MD
Rural - Urban - International
Small Practice - Big Practice -
District Hospital - University -
Rural Clinic - Inpatient -
Outpatient
WHAT’S WRONG WITH MY OWN
         HEALTH?
WHAT’S WRONG WITH
                 HEALTH CARE?
                           (partial list)

•Conflicts   of interest*
•Ineffective   for many things
•Lack   of interactivity and empowerment
•Poor   customer service
WHO MIGHT BENEFIT FROM
A SELF-TRACKING PARADIGM?
Diagnosed medical
problem not adequately
treated by conventional
paradigm
Symptoms or syndromes not
adequately diagnosed by
conventional paradigm
Desire to identify environmental,
food, contextual or social
contributors to symptoms
Desire for behavior or lifestyle change
Or just a desire to be involved
in the process
A FEW HIGH-YIELD DIAGNOSES

•Irritable                   •Psoriasis
        Bowel
 Syndrome                    •Addiction
•Chronic     Fatigue         •Diabetes    Mellitus
•Noncardiac     Chest Pain   •Anxiety
•Depression                  •Headaches
2007-present
Founded My Doctor Medical Group
in San Francisco
THE PROMISE:
GATHER DATA AND BENEFIT FROM FEEDBACK!
BUT MOST PEOPLE
CAN’T PULL IT OFF BY THEMSELVES

(AND/OR HAVE A COMPLICATED MEDICAL ISSUE)
Doctor      Quant Coach

             Self-Tracker
Other Team
 Members
               Patient
THE QUANT COACH


•A   distinct member of the health care team
•Different   skill set from a doctor
•Not  burdened by the doctor-patient power
differential
SELF TRACKING CULTURE

•Personal  narrative
•Iterative process
•Specific problems and terminology
SELF TRACKING CULTURE

      •Choose  appropriate tools
      •Reflection on specific incidents

( Reflect - adjust - track )

                         insights and progress
DAVID

        50 years old
         Engineer
           Stoic
DAVID

3 month gradual onset
       Exertional but intermittent:
             Shortness of breath
                 Chest discomfort
                        “Palpitations”
DAVID

Labs
   EKG
   Echocardiogram
         Hospital admission
              Stress echo
DAVID



   “Everything is normal”
        So now what?
DAVID
   Dietary Sensitivity?

Reflux?               Work Stressor?
                                      Arrhythmia?
   Environmental trigger?
                             Poor sleep?
         Panic Disorder?
Mymee App




 Dyspnea                 Chest Pain   Cold

                                             Indoor Air Quality Meter
Palpitations   Dyspnea    People      Food




                                                                        Sleep EEG
Dyspnea
But it’s not really about the data
But it’s not really about the data

    It’s about the process
WHERE ARE WE NOW:
             BETA TESTING

•Quant   coaching in NYC - nonmedical
•Quant   coaching in Pittsburgh, PA - nonmedical
•Quant   coaching in SF - medically supervised
              (My Doctor Medical Group)
HOW TO FIX HEALTH CARE?
Top down -- Electronic health exchange, “big data”
analytics, performance measures, Accountable Care
Organizations, Patient Centered Medical Homes, apps for
providers and systems.

                                 Meh.
HOW TO FIX HEALTH CARE?




Bottom up -- Self tracking, own your own data,
quant coaching, personal experiments, doctor as
collaborator and consultant. Artful and appropriate
use of technology.
CONTACT ME
Paul Abramson MD
My Doctor Medical Group
     San Francisco

     Tel 415-963-4431
Twitter @paulabramsonmd
 ADN @paulabramsonmd

  mydoctorsf.com
  quantdoctor.com

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Self Tracking in a Medical Context: The Quant Coach

  • 1. THE QUANTIFIED DOCTOR Self Tracking and Medical Care Paul Abramson MD My Doctor Medical Group UCSF Clinical Faculty @paulabramsonMD
  • 2. “Many of the people who come to my office .. have come because modern medicine has failed them in some way, or they have used up its power to help them and they know not what else to do” -- Rachel Naomi Remen, MD
  • 3. BS, MS Electrical Engineering
  • 5. Rural - Urban - International Small Practice - Big Practice - District Hospital - University - Rural Clinic - Inpatient - Outpatient
  • 6. WHAT’S WRONG WITH MY OWN HEALTH?
  • 7. WHAT’S WRONG WITH HEALTH CARE? (partial list) •Conflicts of interest* •Ineffective for many things •Lack of interactivity and empowerment •Poor customer service
  • 8. WHO MIGHT BENEFIT FROM A SELF-TRACKING PARADIGM?
  • 9. Diagnosed medical problem not adequately treated by conventional paradigm
  • 10. Symptoms or syndromes not adequately diagnosed by conventional paradigm
  • 11. Desire to identify environmental, food, contextual or social contributors to symptoms
  • 12. Desire for behavior or lifestyle change
  • 13. Or just a desire to be involved in the process
  • 14. A FEW HIGH-YIELD DIAGNOSES •Irritable •Psoriasis Bowel Syndrome •Addiction •Chronic Fatigue •Diabetes Mellitus •Noncardiac Chest Pain •Anxiety •Depression •Headaches
  • 15. 2007-present Founded My Doctor Medical Group in San Francisco
  • 16. THE PROMISE: GATHER DATA AND BENEFIT FROM FEEDBACK!
  • 17. BUT MOST PEOPLE CAN’T PULL IT OFF BY THEMSELVES (AND/OR HAVE A COMPLICATED MEDICAL ISSUE)
  • 18. Doctor Quant Coach Self-Tracker Other Team Members Patient
  • 19. THE QUANT COACH •A distinct member of the health care team •Different skill set from a doctor •Not burdened by the doctor-patient power differential
  • 20. SELF TRACKING CULTURE •Personal narrative •Iterative process •Specific problems and terminology
  • 21. SELF TRACKING CULTURE •Choose appropriate tools •Reflection on specific incidents ( Reflect - adjust - track ) insights and progress
  • 22. DAVID 50 years old Engineer Stoic
  • 23. DAVID 3 month gradual onset Exertional but intermittent: Shortness of breath Chest discomfort “Palpitations”
  • 24. DAVID Labs EKG Echocardiogram Hospital admission Stress echo
  • 25. DAVID “Everything is normal” So now what?
  • 26. DAVID Dietary Sensitivity? Reflux? Work Stressor? Arrhythmia? Environmental trigger? Poor sleep? Panic Disorder?
  • 27. Mymee App Dyspnea Chest Pain Cold Indoor Air Quality Meter Palpitations Dyspnea People Food Sleep EEG
  • 29. But it’s not really about the data
  • 30. But it’s not really about the data It’s about the process
  • 31. WHERE ARE WE NOW: BETA TESTING •Quant coaching in NYC - nonmedical •Quant coaching in Pittsburgh, PA - nonmedical •Quant coaching in SF - medically supervised (My Doctor Medical Group)
  • 32. HOW TO FIX HEALTH CARE? Top down -- Electronic health exchange, “big data” analytics, performance measures, Accountable Care Organizations, Patient Centered Medical Homes, apps for providers and systems. Meh.
  • 33. HOW TO FIX HEALTH CARE? Bottom up -- Self tracking, own your own data, quant coaching, personal experiments, doctor as collaborator and consultant. Artful and appropriate use of technology.
  • 34. CONTACT ME Paul Abramson MD My Doctor Medical Group San Francisco Tel 415-963-4431 Twitter @paulabramsonmd ADN @paulabramsonmd mydoctorsf.com quantdoctor.com

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